Lecture 1: From anxiety to disorder
Fear =
a state of immediate alarm in response to a serious, known threat to one’s well-being
- an emotional response to a perceived threat
- adaptive and has evolutionary value
- humans are predisposed biologically
- involves activation of the sympathetic nervous system
- ‘fight or flight’ phenomenon
Anxiety =
a state of alarm in response to a vague sense of threat or danger
- Normal anxiety is adaptive. It is an inborn response to threat or to the absence of
people or objects that signify safety can result in cognitive (worry) and somatic
(racing heart, sweating, shaking, freezing) symptoms.
- Pathological anxiety is anxiety that is excessive and impairs function.
→ Both have the same physiological features: increase in respiration, perspiration, muscle
tension, etc.
DSM-Definition
1. unreasonably strong or permanent
2. arises without sufficient reason
3. cannot be controlled or endured
4. causes suffering and constraints life
5. typical symptom patterns are present
Fear is easier to treat with exposure because there is a clear trigger compared to anxiety.
,Avoidance behavior is creating a physical or psychological distance from something you
perceive as threatening like a situation, object, thought, feeling, or memory.
→ adaptive = avoiding real threats (e.g. not walking into traffic)
→ maladaptive = avoiding perceived threats when there is no real danger (e.g. not taking
the train due to fear of panic)
Avoidance prevents learning that the feared thing might not be dangerous, which keeps the
fear going
1. overt avoidance =
leaving the supermarket during a panic attack
2. pre-encounter avoidance =
not going to the supermarket at all
3. safety behavior =
only going to the supermarket when someone else comes along
4. covert / experiential avoidance =
doing mental arithmetic to distract from bodily sensations
Lifetime prevalence for any anxiety disorder ranges from 10% to 29%
The 12 month prevalence is 18%
,Diversity in anxiety disorders
Expression varies across cultures
- somatic focus (e.g. headaches, dizziness) more prominent in some groups
- e.g. in some latin american communities, panic symptoms may be described as
‘nerves in the chest leading to visits to the GP or emergency room rather than mental
health care
Risk is not evenly distributed
- Higher prevalence in women LGBTQ+ individuals, and marginalized communities
- Linked to chronic stress, discrimination, and reduced access to resources
- Meyer’s Minority Stress Model (2003)
, Etiology of mental disorders
The maintaining factors are treated in therapy.
Social support and optimism are the 2 most important protective factors.
SUSCEPTIBILITY, VULNERABILITY, AND PREDISPOSITION
Biological causes - genetic influences
1. There is increasing evidence that we inherit a tendency to be tense or uptight
2. No single gene has been identified to cause anxiety
3. A tendency to panic also seems to run in families
4. BUT anxiety and fear states are highly heterogeneous (they consist of very different
parts)
There seem to be underlying psychological or biological vulnerability factors for anxiety
disorders in general, which may already manifest in children. Possible risk factors are
behavioral inhibition and higher autonomic reactivity: enhanced startle reflex and respiratory
sensitivity.
Epigenetics =
- changes in gene expression that don’t involve changes to the DNA sequence itself
- influenced by environmental factors (stress, trauma, lifestyle)
These changes may increase vulnerability to anxiety disorders by affecting brain function.
Brain areas that are affected are
1. amygdala: responsible for processing fear
2. prefrontal cortex: regulates emotional responses
3. hippocampus: memory and stress response regulation
Studies show that early life stress can lead to long-term changes in gene expression related to
stress response systems.
Fear =
a state of immediate alarm in response to a serious, known threat to one’s well-being
- an emotional response to a perceived threat
- adaptive and has evolutionary value
- humans are predisposed biologically
- involves activation of the sympathetic nervous system
- ‘fight or flight’ phenomenon
Anxiety =
a state of alarm in response to a vague sense of threat or danger
- Normal anxiety is adaptive. It is an inborn response to threat or to the absence of
people or objects that signify safety can result in cognitive (worry) and somatic
(racing heart, sweating, shaking, freezing) symptoms.
- Pathological anxiety is anxiety that is excessive and impairs function.
→ Both have the same physiological features: increase in respiration, perspiration, muscle
tension, etc.
DSM-Definition
1. unreasonably strong or permanent
2. arises without sufficient reason
3. cannot be controlled or endured
4. causes suffering and constraints life
5. typical symptom patterns are present
Fear is easier to treat with exposure because there is a clear trigger compared to anxiety.
,Avoidance behavior is creating a physical or psychological distance from something you
perceive as threatening like a situation, object, thought, feeling, or memory.
→ adaptive = avoiding real threats (e.g. not walking into traffic)
→ maladaptive = avoiding perceived threats when there is no real danger (e.g. not taking
the train due to fear of panic)
Avoidance prevents learning that the feared thing might not be dangerous, which keeps the
fear going
1. overt avoidance =
leaving the supermarket during a panic attack
2. pre-encounter avoidance =
not going to the supermarket at all
3. safety behavior =
only going to the supermarket when someone else comes along
4. covert / experiential avoidance =
doing mental arithmetic to distract from bodily sensations
Lifetime prevalence for any anxiety disorder ranges from 10% to 29%
The 12 month prevalence is 18%
,Diversity in anxiety disorders
Expression varies across cultures
- somatic focus (e.g. headaches, dizziness) more prominent in some groups
- e.g. in some latin american communities, panic symptoms may be described as
‘nerves in the chest leading to visits to the GP or emergency room rather than mental
health care
Risk is not evenly distributed
- Higher prevalence in women LGBTQ+ individuals, and marginalized communities
- Linked to chronic stress, discrimination, and reduced access to resources
- Meyer’s Minority Stress Model (2003)
, Etiology of mental disorders
The maintaining factors are treated in therapy.
Social support and optimism are the 2 most important protective factors.
SUSCEPTIBILITY, VULNERABILITY, AND PREDISPOSITION
Biological causes - genetic influences
1. There is increasing evidence that we inherit a tendency to be tense or uptight
2. No single gene has been identified to cause anxiety
3. A tendency to panic also seems to run in families
4. BUT anxiety and fear states are highly heterogeneous (they consist of very different
parts)
There seem to be underlying psychological or biological vulnerability factors for anxiety
disorders in general, which may already manifest in children. Possible risk factors are
behavioral inhibition and higher autonomic reactivity: enhanced startle reflex and respiratory
sensitivity.
Epigenetics =
- changes in gene expression that don’t involve changes to the DNA sequence itself
- influenced by environmental factors (stress, trauma, lifestyle)
These changes may increase vulnerability to anxiety disorders by affecting brain function.
Brain areas that are affected are
1. amygdala: responsible for processing fear
2. prefrontal cortex: regulates emotional responses
3. hippocampus: memory and stress response regulation
Studies show that early life stress can lead to long-term changes in gene expression related to
stress response systems.
